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M3 Pharm B2 > Anti-hypertensives (Cardio and Renal 1) > Flashcards

Anti-hypertensives (Cardio and Renal 1) Flashcards

1
Q

6 Types of Heart Drugs

A
  1. Anti-hypertensives
  2. Anti-arrhythmias
  3. Anti-anginal drugs
  4. Drugs used in MI
  5. Drugs used in heart failure
  6. Anti-hyperlipidemic drugs
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2
Q

10 Types of Anti-Hypertensives

A
  1. Diuretics
  2. Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors or ACEI)
  3. Angiotensin Receptors Blockers (ARB)
  4. Beta Blockers (BB
  5. Calcium Channel Blockers (CCB)
  6. Alpha 2 Agonist
  7. Adrenergic Neuronal Blocking Drugs
  8. Alpha Blockers
  9. Direct Acting Vasodilators
  10. Renin Inhibitors: Aliskiren
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3
Q

Which classes of Anti-hypertensive drugs have proven to decrease mortality from heart disease (3)?

A
  1. Beta Blockers
  2. ACE Inhibitors
  3. Thiazide Diuretics
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4
Q

What’s hypertension?

A

Elevated systolic, diastolic, or BOTH.

Normal: 120/80

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5
Q

When are anti-hypertensives indicated? Stage I Hypertension

A

Stage I Hypertension

Diastolic = 90-99

Recommended: Thiazide diuretic

Consider: ACEI, ARB, BB, or CCB

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6
Q

When are anti-hypertensives indicated? Stage II Hypertension

A

Diastolic = >100

Recommended: *Two-drug combination (Stage II, 2-drug combo)
e.g. Thiazide diuretics + ACEI OR Thiazide diuretics + ARB + BB + CCB

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7
Q

Pre-Hypertension

A

Diastolic = 80-89

Recommended: Life style modification -* weight reduction, moderate alcohol, regulary exercise, reduced sodium, *smoking cessation

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8
Q

If patient presents with hypertension + medical condition, then what’s the approach?

A

Hypertension + (Compelling indications)

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9
Q

Hypertension and angina pectoris

A

BB, CCB

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10
Q

Hypertension and BPH

A

Alpha blocker

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11
Q

Hypertension and diabetes

A

ACE Inhibitors, ARB

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12
Q

Hypertension and heart failure

A

ACE Inhibitors, ARB, BB

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13
Q

Hypertension in patient AFTER having MI

A

BB

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14
Q

Hypertension and hyperlipidemia

A

Alpha blocker, CCB

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15
Q

Refractory Hypertension

A

Hypertension that is not responding to combination therapy

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16
Q

Drug choice for pregnant female with Pre-Eclampsia (high BP)

A

Labetalol

Consider: Hydralazine- Nifedipine-Nitroglycerin

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17
Q

Mechanisms affecting BP: Formulas

A

BP = CO x TPR

CO = SV x HR

BP = SV x HR x TPR

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18
Q

Mechanisms affecting BP: Increased SV (Edema, increased renin-angiotensin activity)

A

Rx: Diueretics, ACE Inhibitors

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19
Q

Mechanisms affecting BP: Increased HR (due to decreased vagal tone and increased sympathetic tone)

A

Rx: BB

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20
Q

Mechanisms affecting BP: Increased peripheral resistance (Increased sympathetic tone)

A

Rx: Alpha 2 agonist
Alpha Blockers
CCB
Direct acting vasodilators

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21
Q
  1. Diuretics: Types (5)
A
  1. Thiazides diuretics (Early distal tubule)
  2. Loop diuretics (Thick Ascending Limb of Loop)
  3. Osmotic diuretics (Proximal tubules, Loop of Henle, and Collecting duct)
  4. Carbonic Anhydrase inhibitors (Proximal tubules)
  5. Potassium-sparing diuretics (Late distal tubule, and collecting duct)
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22
Q
  1. Diuretics: Thiazides
A

Rx: Chlorothiazide, Hydrochlorothiazide, *Chlorthalidone, **Indapamide *Metalozone

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23
Q
  1. Diuretics: Thiazides - MOA *(4)
A

Inhibit Na/Cl cotransport

Increase excretion of: Na+, K+, Cl+, Mg+, and HCO3

Decrease excretion of: Ca, uric acid

*Reduces symptoms of both central and nephrogenic diabetes insipidus by persistent extracellular volume depletion AND decreased GFR

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24
Q
  1. Diuretics: Thiazides - Side Effects
A

Hypo everything except calcium –> hyper alchemical and hyperuricemia

Metabolic Alkalosis

Increase plasma cholesterol and TGs (except **indapamide)

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25
Q
  1. Diuretics: Loop Diuretics
A

Rx: Furosemide, Bumetanide, Torsemide, Ethacrynic acid

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26
Q
  1. Diuretics: Loop Diuretics - MOA
A

Inhibit Na+/K+ dicholride cotransport system

Increase excretion of Na, K, Mg, Cl, HCO3, Ca

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27
Q
  1. Diuretics: Loop Diuretics - Side effects
A

Buzzword: Ototoxicity

HYPO EVERYTHING

Metabolic alkalosis

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28
Q
  1. Diuretics: Loop Diuretics - Drug Interactions
A

Loop diuretic + Antibiotic (aminoglycosides) —-> Increased risk for ototoxicity

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29
Q
  1. Diuretics: Osmotic Diuretics
A

Rx: Mannitol and Urea

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30
Q
  1. Diuretics: Osmotic Diuretics - MOA
A

Increase the osmotic pressure in the proximal tubule –> inhibition of reabsorption of water and electrolytes

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31
Q
  1. Diuretics: Osmotic Diuretics - *Indications
A

*Increase intra-cranial and intra-ocular pressure

Acute renal failure

32
Q
  1. Diuretics: Carbonic Anydrase Inhibitors
A

Rx. Acetazolamide, Dorzolamide

33
Q
  1. Diuretics: Carbonic Anydrase Inhibitors - MOA
A

Increase excretion of Na+, K+, and HCO3

34
Q
  1. Diuretics: Carbonic Anydrase Inhibitors - Side Effects
A

Hyperchloremic metabolic acidosis (normal anion gap acidosis), hypokalemia

35
Q
  1. Diuretics: Carbonic Anydrase Inhibitors - Indications
A

Rx of glaucoma, and overdose of acidic drugs

Why?

36
Q
  1. Diuretics: Potassium-Sparing Diuretics
A

Rx: Spironolactone (Aldosterone Antagonist)
Amiloride
Triamterene

37
Q
  1. Diuretics: Potassium-Sparing Diuretics MOA
A

Block Na+ reabsorption

Block K+ secretion (spare K+)

38
Q
  1. Diuretics: Potassium-Sparing Diuretics - Side Effects
A

*Hyperkalemia, metabolic acidosis

Nephrolithiasis (triamterene)

Decreased libido (spironolactone)

39
Q
  1. Diuretics: Potassium-Sparing Diuretics - Eplerenone (New)
A

Similar to spironolactone with less side effects

40
Q
  1. Diuretics: Potassium-Sparing Diuretics - Indications 1
A

*Spironolactone + ACEI increased survival in heart failure

**Spironolactone has an anti-androgenic effect: rx for hirsutism

41
Q
  1. Diuretics: Potassium-Sparing Diuretics - Indications 2
A

Amiloride used as rx for Nephrogenic DI caused by lithium

What drug is used for rx for Nephrogenic DI? (Thiazides to excrete water and Na, check slide 26 to confirm)

42
Q
  1. ACE Inhibitors: Buzzword
A

Drugs ending with “pril” - 7

Captopril

Enalapril –> IV for hypertensive emergency (Diastolic above 120 and Systolic above 200 WITH SYMPTOMS)

Lisinopril

Fosinopril –> no dose adjustment in renal failure

Benazepril

Quinapril

Ramapril

43
Q
  1. ACE Inhibitors: MOA
A

Inhibit ACE (thus no AT II, and also inhibits inactivation of bradykinin –> so, bradykinin is still active and can cause vasodilation)

Side effect: Dry cough

44
Q

What drugs are the best for hypertension in diabetes?

A

ACE Inhibitors because diabetic patients tend to get nephropathy. ACE Inhibitors slow down renal damage

45
Q
  1. ACE Inhibitors: Contraindications
A

HYPERkalemia and acute renal failure (proteinuria)

46
Q
  1. ACE Inhibitors: Contraindicated During Pregnancy
A

Contraindicated in 2nd and 3rd trimester –> leads to fetopathy

Also, oligohydramnios, IUGR, hypocalvaria, and renal failure

47
Q
  1. ARB (AT II Receptor Blockers)
A

Buzzword: Drugs ending in “sartan”

Losartan
Valsartan
Candesartan
Irbesartan

*NO DRY COUGH because no bradykinin involved

48
Q
  1. ARB (AT II Receptor Blockers) : MOA (*2)
A

Block AT II (type I, at AT-1 receptors) —> reducing vasconstriction

*Increases ability of kidney to excrete sodium when plasma renin is 3-4x higher than normal

49
Q
  1. ARB (AT II Receptor Blockers): Adverse Reactions
A

Acute renal failure

Contraindicated in pregnancy

50
Q
  1. Beta Blockers (BB)
A

Buzz word: Drugs ending in “olol”

Propranolol —> Hyperthyroidism

Atenolol - Selective B1-blocker

Metoprolol - Selective B1-blocker

Bisoprolol - Selective B1-blocker

Labetalol - Selective alpha and non-selective B blocker

51
Q
  1. Beta Blockers (BB): Third Generation (2)
A

Nebivolol - Selective B1 blocker with antioxidant properties

Carvedilol - Third generation alpha and beta blocker

52
Q
  1. Beta Blockers (BB): Indications (4)
A
  1. Coronary Artery Disease
  2. Tachy-arrhythmia
  3. Migraine headaches
  4. Anxiety
53
Q
  1. Beta Blockers (BB): Contraindications
A

Asthma, heart attack

54
Q
  1. Beta Blockers (BB): Adverse Effects
A

Bronchospasm, fatigue, glucose intolerance

55
Q
  1. Beta Blockers (BB): Cautions (2)
A
  1. Mask signs of hypoglycemia
  2. Abrupt withdrawal can cause hypertension
    Upregulation of # of receptors
56
Q
  1. ***CCB
A

Drugs ending in “dipine:

Amlodipine - Most commonly prescribied

Nifedipine

Isradipine

Feldopine

Nicardipine
Buzz word: Dihydropyridinees (peripheral tissues, dilate)

***Exception
Non-hydropyridines (heart): Diltiazem and Verapamil
Works for hypertension and arrhythmias

57
Q
  1. CCB: MOA
A

Block the L-type Ca2+ channels

58
Q
  1. CCB: Dihydro-pyridines
A

Buzzword: Reflex tachycardia, flushing, ankle edema

59
Q
  1. CCB: Non-dihydropyridines
A

Buzzword: Decrease cardiac contractility, possible AV block

60
Q
  1. CCB: Indications (3)
A

Angina pectoris
Peripheral vascular disease
Tachy-arrhythmia

61
Q
  1. CCB: Nimodipine is approved for?
A

Acute subarachnoid hemorrhage

Prevents post hemorrhagic vasospasm

62
Q

Who respond to CCBs well?

A

African Americans and elderly

63
Q
  1. Alpha 2 Agonist: Clonidine
A

Mild to moderate hypertension (patches cause less side effects)

Side effects: Edema, rebound hypertension after sudden withdrawal

64
Q
  1. Alpha 2 Agonist: Alpha Methyldopa
A

Mild to moderate hypertension

Side effects: + Coombs test –> hemolytic anemia

Safe in pregnancy and renal dysfunction

65
Q
  1. Adrenergic Neuronal Blocking Drugs: Guanethidine
A

Binds to storage vesicles and inhibit release of NE

Side effects: Fluid retention

Contraindicated with antidepressants

66
Q
  1. Adrenergic Neuronal Blocking Drugs: Reserpine
A

Binds to storage vesicles and destroys them

Causes depletion of NE, DA, and serotonin

Side effects: Psychotic depression and suicide

67
Q
  1. Alpha Blockers: Rx and Use
A

“Dox Pra Tera”

Rx: Doxazocin, Prazocin, Terazocin

Lower BP and used for BPH

68
Q
  1. Alpha Blockers: Side Effects
A

First dose of syncope, orthostatic hypotension

69
Q
  1. Alpha Blockers: What happens when women cough, sneeze, or try to lift weights?
A

Incontinence because of the alpha blockade effect on the bladder and sphincter

70
Q
  1. Direct Acting Vasodilators: Hydralazine (*4)
A

Relaxes arteriolar smooth muscle

Side effects: Reflex tachycardia, palpitations (use a BB)

Buzz word: SLE like syndrome and hemolytic anemia

Not used alone as an anti-hypertensive drug because its tolerance to the anti-hypertensive action develops early due to counter regulatory mechanism

71
Q
  1. Direct Acting Vasodilators: Sodium Nitroprusside
A

Dilate both resistance and capacitance vessels

Long term side effects: accumulation of cyanide and thiocyanate

Buzzword: Choice for hypertensive crisis (IV)

72
Q
  1. Direct Acting Vasodilators: Minoxidil
A

Prodrug which after sulfation appears to activate K+ channels

Side effects: Hypertrichosis (abnormal hair growth)
Buzzword: Rogaine (topically for baldness)

73
Q
  1. Direct Acting Vasodilators: Diazoxide
A

Activates K+ channels causing relaxation of smooth muscle

Side effects: Hyperglycemia (decrease insulin release from B cells) AND Hypertrichosis

IV Rx of hypertensive emergencies

Used to tx insulinoma
Sulfonylureas (oral hypoglycemics) work n the same type of K+ channel but close them

74
Q
  1. Direct Acting Vasodilators: Fenoldopam
A

Side effects: Headache and nausea

75
Q
  1. Renin Inhibitor
A

Aliskiren

76
Q

What are the 4 drugs for hypertensive emergency with symptoms?

A

Enalapril (ACEI)

Labetolol (BB)

Sodium Nitroprusside (Direct Acting Vasodilator)

Diazoxide (Direct Acting Vasodilator)

M3 Pharm B2 (10 decks)

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